Is there any new information available on eating disorders? My 21-year-old granddaughter has been anorexic and bulimic since age 15, if not earlier. Everything we have tried has failed, including therapy, acupuncture, nutritionists, in-patient stays at numerous eating-disorder clinics and visits to the emergency department for low potassium and/or seizures.

My granddaughter’s knowledge about her disease is limited, and she refuses to participate in any support groups. She has been prescribed escitalopram (Lexapro) daily plus potassium supplements. I am very concerned for her safety. — Dorothy Binkley, CRNP (Retired), Columbia, Md.

I am sure this is very distressing for you. Therapies can be limited by the individual’s willingness to participate and desire to become well. However, I recently participated in a wonderful update on eating disorders through TeenScreen – National Center for Mental Health Checkups at Columbia University.

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There is some good evidence out there now on the effectiveness of the Maudsley Approach, a family-based treatment approach for teenagers. There is also a manual for this treatment (Lock J, Le Grange D, Agras WS, Dare C. “Treatment Manual for Anorexia Nervosa: A Family-Based Approach.” New York, N.Y.: The Guilford Press; 2002). Although the patient you describe is 21 years old, she may still be functioning at the older teen/young adult level, and the Maudsley Approach may be worth a try.

For adults with anorexia nervosa, the best bet appears to be cognitive behavior therapy, which has also been shown to be effective for bulimia. — Julee B. Waldrop, DNP (164-1)